“Don’t get Ultherapy if you have little facial fat” is a comment often seen in online communities. Having little facial fat does not automatically rule out treatment. However, a face with less volume calls for especially careful decisions about where, and at what depth, to deliver the energy.
If sagging is your concern, facial volume and skin condition need to be assessed together
The first step is to distinguish volume loss from sagging.
Volume loss — Reduced fullness in the cheeks or temples. Ultherapy alone cannot fill these areas, so other options are discussed as well.
Sagging — Skin that has loosened along the jawline or lower cheeks. This is the type of concern Ultherapy addresses.
“When someone has sagging even though they have little facial fat, lifting is still something we need to consider.”
The same 4.5 mm depth reaches different layers in different people and areas
Depending on the tip, Ultherapy focuses energy at a set depth, such as 1.5 mm, 3.0 mm, or 4.5 mm. What lies at that depth, however, varies by area.
Mean values, in mm
Superficial fat thickness varies considerably across the face
The vertical dashed lines mark Ultherapy focal depths.
On average, skin and superficial fat around the nasal dorsum total approximately 3.1 mm. Around the mouth, the superficial fat layer alone measures 5.14 mm, thicker than 4.5 mm. Its standard deviation is 3.31 mm; even the mean ± one standard deviation spans approximately 1.8–8.5 mm.
There is considerable variation between people, even in the same area. Treatment depth is decided by examining the individual’s tissue layers.
Areas ranked from thinner to thicker superficial fat
Thinner → Thicker
1. Nasal root and dorsum
2. Above the eyebrows
3. Forehead
4. Temples
5. Cheeks
6. Under the eyes
7. Around the mouth
How to read these findings: This anatomical study measured 53 cadavers. It did not directly study Ultherapy.
This is also the paper Medical Director 유동균 presented in a lecture slide during AMI physician training in December 2025.
Fat loss is an uncommon adverse effect, but it has been reported
A 2025 systematic review summarized adverse events from 19 Ultherapy papers involving 506 patients. Common events were temporary swelling, redness, and pain; there was 1 case of subcutaneous fat atrophy.
However, among the 106 reports in the US FDA’s adverse-event database (MAUDE) examined by the same study, fat atrophy was frequently reported. Many reports were unverified, so they cannot establish how often this occurs. Still, concern about cheek hollowing is not without a basis.
That is why location and depth come before shot count
“Using the same 600 shots and the same tip, whether someone has a lot of facial fat or very little… may lift some faces, while a face with little fat may look more hollow…”
V Clinic Gangnam uses SKENA to assess the skin, fat, and muscle layers. The findings guide the choice of tips and the allocation of shots in each zone.
What to keep: A personalized chart showing the number of shots for each area makes it easier to compare treatment plans at a later visit.
The tissue layers are checked on-screen again during treatment
Ultherapy PRIME delivers energy while the clinician views a cross-sectional ultrasound image beneath the skin. This allows the pre-treatment plan to be checked against the actual tissue layers during the procedure.
After treatment, look toward three months rather than one
Ultherapy uses heat to create small coagulation points. Changes build as new collagen forms around them. The tight feeling immediately after treatment is temporary; losing that sensation does not necessarily mean the treatment effect has disappeared.
“Even if the effect seems limited at one month… it is worth waiting a little longer, to around three months.”
Skin elasticity measurements after a single treatment fell temporarily at week 4 and were higher than baseline at weeks 12 and 24. The study followed 22 women with sagging along the jawline and under the chin for 24 weeks. These are results from the cited study, not from V Clinic Gangnam.
If you decide to proceed, ask how to check authenticity with your phone
Before treatment, ask the clinic how to verify the authenticity of the device and tips. The team can explain NFC and QR-code checks and whether verification is available on-site.
1. Hold your phone near the device’s NFC tag · Check device authenticity
2. Scan the tip’s QR code · Check tip authenticity
The research behind this article
Regional thickness of facial skin and superficial fat: Application to the minimally invasive procedures. Kim YS, Lee KW, Kim JS, Gil YC, Tansatit T, Shin DH, Kim HJ · Clin Anat. 2019;32(8):1008–1018
“understanding the regional thickness and distribution of the facial superficial fat is essential”
Understanding how superficial facial fat varies in thickness and distribution across different areas is essential.
• Three-dimensional scans of 53 adult Korean and Thai cadavers were used to calculate thickness in seven facial areas.
• Superficial fat: nasal root and dorsum, 1.61 ± 1.07 mm (thinnest); around the mouth, 5.14 ± 3.31 mm (thickest).
• Limitations: Measurements were taken from embalmed cadavers and may differ from living tissue. This was not an Ultherapy study.
Frequently asked questions
If I have little facial fat, could Ultherapy make my face look more hollow?
When volume is limited, cheek hollowing may become more noticeable. Treatment zones and depths therefore need especially careful planning.
Don’t more shots produce better results?
Where the energy is delivered, and at what depth, comes before the number of shots. During consultation, ask how many shots are planned for each zone.
It has been a month and I cannot see a difference. Has the treatment failed?
One month is too early to judge. In a small study of 22 people, elasticity measurements were higher than baseline at weeks 12 and 24. The degree and timing of change vary between individuals.
Before treatment: what to know
• Results and their duration vary with skin condition, age, and lifestyle.
• Redness, swelling, and, less commonly, bruising may occur and are usually temporary. Fat atrophy and nerve-related symptoms have also been reported rarely. If unusual symptoms persist, return to the clinic promptly for advice.
• Makeup may be applied from 4 hours after treatment.
• Avoid alcohol, smoking, saunas, and strenuous exercise for 1–2 weeks after treatment.
• If sagging is severe, nonsurgical lifting alone may not achieve the change you want. Other options can be discussed during consultation.
References
Kim YS, Lee KW, Kim JS, et al. Regional thickness of facial skin and superficial fat: Application to the minimally invasive procedures. Clin Anat. 2019;32(8):1008–1018. https://doi.org/10.1002/ca.23331
Humphrey VS, Rambhia PH, Gmyrek R, Chapas A. Microfocused Ultrasound With Visualization: A Systematic Review of Adverse Events and Risk of Subsequent Facelift Compromise. Dermatol Surg. 2025;51(4):424–429. https://doi.org/10.1097/DSS.0000000000004510
Kerscher M, Nurrisyanti AT, Eiben-Nielson C, et al. Skin physiology and safety of microfocused ultrasound with visualization for improving skin laxity. Clin Cosmet Investig Dermatol. 2019;12:71–79. https://doi.org/10.2147/CCID.S188586
The clinician
유동균, Medical Director · V Clinic Gangnam · Juvéderm Key Doctor. Full member of the Korean aesthetic surgery and laser medicine and clinical aesthetic medicine societies.
This content provides information to help readers understand treatment and does not replace diagnosis or treatment. Whether to proceed and which method to use are decided after a clinical examination. For aftercare, follow the instructions given by the clinical team on the day of treatment.
The illustrations are schematics drawn from the numerical data in the cited papers.
Continue the Ultherapy series
Part 1 · What We Check Before Discussing 600 Ultherapy Shots — https://vclinicfitnote.com/en/m/beui/articles/ultherapy-before-shot-count
Part 3 · Can You Have Ultherapy After Work? — https://vclinicfitnote.com/en/m/beui/articles/ultherapy-after-work
Medical Director of V Clinic Gangnam. Juvéderm Key Doctor. Full member of the Korean aesthetic surgery and laser medicine and clinical aesthetic medicine societies.
Can You Have Ultherapy After Work?
Consult with V Clinic Gangnam
Every skin has its own story. Explore the right approach for yours with our medical team.
15F Seosan Building, 441 Gangnam-daero, Seocho-gu, Seoul, Korea
Mon–Fri 10:00–20:00; Sat–Sun 10:00–17:00; no lunch break
This content provides general health information. Treatment results and effects vary with individual skin conditions. Side effects may occur. Consult a qualified medical professional before making treatment decisions.
